Building A Sanctuary: Fighting Cancer By Making A Video Game

A couple of weeks ago, I wrote about Crashlands, a mash-up of Diablo, Pokemon, and Don’t Starve lobbed at Steam’s collective face with unfettered glee. It’s ambitious, funny, and fun. Turns out, it was conceived when its creator found out he had cancer.

Sam Coster is the founder of Butterscotch Shenanigans, a small game development studio where he’s now the principle (also only) artist. For a while, it was just him and his brother Seth, and they made small, silly mobile games together. They weren’t terrible, but they were ultimately forgettable. Then Sam got diagnosed with cancer, and he decided it was time to do or, well, die.

Kotaku: You got diagnosed with cancer and decided to make a video game while fighting it. Why, and why this particular video game?

Sam Coster: At the time of my diagnosis, we were about four months out from launching our first free-to-play game, which was called Quadropus Rampage, and it’d seen enough success that we thought we could just go down the free-to-play route and make another one of these sort of smaller mobile titles and make enough money to survive. That was always the goal of the studio: survival.

We started working on another mobile game that was sort of an endless runner. You know those Mario levels where you’re riding a horizontal platform and crazy shit’s happening all the time? It’s basically a long form of that. It was coming along well, but then I got my diagnosis. The first couple weeks of that were nuts. It was this whirlwind of biopsies and bone marrow tests and all sorts of stab wounds and stuff. Every time they delivered a piece of news about what would be happening, things looked more and more dire. So first it was like, “You have cancer.” Then it was like, “It’s non-Hodgkin’s lymphoma, which is worse than normal.” Then it was like, “Oh, it’s stage 4B. It’s a super rare one that you’re not supposed to get until you’re, like, 70!”

I was with my family at the time, and I started the first treatment. We went out to an Indian restaurant afterwards and had a sort of celebratory meal. The treatment’s really weird because it’s so casual. It’s like you’re in a bus stop. You’re in a crowded room and there are all these people sitting in chairs. And then you get this poison pumped into you. You don’t feel the effects of it for between 6 and 12 hours. So I was still fine that night, but then the next morning I woke up and felt like I got hit by a ton of bricks.

Then my brother Seth came over so we could start working on our game again. We both like working, and not being able to work for a whole month when our studio was in such an early and fragile state was a scary idea. We sat down to work, and he started going over the code and asking what I wanted to do about particular problems and all this other stuff. I just looked at him and said, “I don’t want this to be the last game I make before I die.”

“No offense, but it’s a mobile endless runner,” I said. “Everyone’s going to forget about this in six minutes. It might make a dime for the studio, but who gives a fuck?” I wanted to do something that at least had a little more cultural memory for someone, or even to make something that could help someone in a similar situation to my own. I prototyped the equivalent of a Roomba. It picked up leaves. That was the auspicious beginning of Crashlands.

Kotaku: What was the initial seed underlying that idea? What was the goal of the game in your mind?

Sam Coster: The initial seed was to build a place I could escape to while undergoing treatments. An easy example of that is, I started this drug called Methotrexate, which is an extremely powerful chemotherapy drug. You have to get a really high dose of it to have it act as a prophylactic against the lymphoma getting into your brain. I was in the hospital for the first time for it, and it was a little more brutal than the other drug I’d been on. Seth sent me a note, and he was like, “Hey, you want me to come over tonight? We can hang out and play some games in the hospital or something.” And I was like, “No, but I do want you to finish programming the gardening so I can build a damn garden in Crashlands tonight.” He’s laughing like “Alright, alright.”

So the goal was to actively build a sanctuary I could go to while I was in one of these really shitty situations.

Kotaku: And the dev team was just you and your brothers?

Sam Coster: Seth and my other brother Adam, who joined on the project about six months later—that was their way of being able to help. In most cancer situations, your friends and family just have to look on while you try not to die. It can be extremely upsetting. For my brothers, I think helping with the game gave them a nice mode of control.

Crashlands was ambitious and, frankly, we had no idea how to do any of the stuff I’d declared that we were going to do to build this huge world. The first time Seth got the world generation working, it took seven minutes to generate the world and only four minutes to run across it. We had no idea what we were doing and no idea how to do what we were doing.

It was just one of those things where, once you know that you’re going to die in a sense, you really change your approach to what you’re doing. You want to be doing stuff that actually matters on the daily. With the timeline they’d given me for stuff, treatment was gonna be six months, and then they’d know if it worked or not. There was about a 60/40 chance that it would work. I figured by the time the treatment was done, we’d be close to wrapping the game up and the cancer would also be gone hopefully. That turned out to very much not be the case.

Kotaku: Oh fuck. What do you mean by that, exactly? In what sense or senses did that not turn out to be the case?

Sam Coster: A great many, I’d say. Crashlands today is a much more polished execution of a big jumble of ideas. I wanted to take everything I loved about games and shove them all together. So Diablo-style stuff, plus some Pokemon-esque taming, plus some world-building, boss fights—all that stuff. The first version of this just didn’t gel at all. We were basically using the modes Terraria, Minecraft, and Pokemon worked with. Like, there used to be an actual capture minigame where you’d have to down a creature and hit it with a special item. We were pulling from all these sources too hard and not letting the game come to fruition in its own way.

It was only after Adam joined on in the summer of 2014 that we finessed a lot of it. That was actually when we just ripped out the inventory management system. There was no more inventory after that. Then we added more and more and more because it was so annoying to deal with, and then Adam came in and he was like, “Why don’t we just... not do that?” Once we did that, all the other stuff started to fall into place. Certainly they’re still inspired by those other games, but they started to come into their own around that time.

But yeah, there were times where it was all a little upsetting. I was going through treatments, and then it was also like, “Oh, I’m building a piece of crap” [laughs]. But I had trust in my brothers to give good feedback and being able to pull it back from whatever brink it was on.

Kotaku: How were the treatments going during that time period? How were you doing physically?

Sam Coster: So my treatments ended around GDC in March 2014. After that, I got a PET scan, and they could still see three glowing nodes in my left chest wall, which is where the whole thing started. The doctors kinda freaked out about that. One was like, “I want you back in treatment tomorrow, back to chemotherapy.” What was gonna follow from that was what’s called salvage chemo. If your cancer recurs in such a short time period, that spells a really bad prognosis. That was a very dark month or so, while we were figuring out what was actually happening.

As it turns out, all that glowing was actually caused by an inflammation in my system. So they did a surgical biopsy, took out some lymph nodes, and checked it out. They could not find any cancer cells whatsoever. It was this insane thing. I don’t know if you’ve seen the episode of Archer where he gets cancer, but the doctor calls him, and he’s like, “You have cancer!” And Archer’s like, “Oh god!” And then ten minutes later the doctor calls him back, and he’s like, “Oops, sorry. Our tests were wrong.” They literally did that to me for, like, a month. Calls every other day for a week. It sort of bounced back and forth. Tests were showing that I conclusively did not have cancer on this very fine level, but the doctors were still terrified.

In that time, I was like, “Fuck this, I’m gonna propose to my girlfriend now because she’s stuck with me the whole time, and she’s been wonderful. So let’s pull the trigger on this before I die.” So we got engaged that summer. After that, I got cleared again, and suddenly I just had all this time to work. It was odd. That was when we finished a lot of the art content for the game. I do all the art. I finished most of my work in that stretch.

In December 2014, my fiancee and I went to visit her family, and they took us on a trip to Florida including Disney World. I’d been feeling great. Back to working out and stuff. I hopped into the shower the first night we were there at the hotel, and out of nervous habit I started feeling my left chest wall where I had the kidney-sized tumour. I felt this marble in there. I was like, “FUCK.” I had a breakdown at that point, and then I went to Disney World because Disney World’s fucking cool.

I called my doctor and asked what to do. They were like, “Go enjoy your vacation, and when you get back we’ll start treatment again.” For some reason it was less terrifying that time, I think because it was gonna be the same treatment we’d been told about back when that sort of false alarm happened in the summer. So we started the chemo again, plus bone marrow transplants. Salvage chemo is way more unfriendly. I did three rounds of that and then began prep for a stem cell treatment. It was a transplant of my own cells first. Now, all of the chemo stuff I tolerated pretty well. I was still able to be up and about. There was various amounts of throwing up, exhaustion, and pain, but I was able to work for a large portion of it. I would just sit in my little chair with a mouse, so I only really need about three inches of space to do work.

The stem cell transplant involved giving my own cells to myself. That’s actually not the curative part. The reason they do it that way is actually a rescue. The chemo they give you is so powerful that it literally kills all of your bone marrow. Your ability to produce blood or an immune system goes away. The reason they give you this chemo is with the single goal of killing the fuck out of the cancer in your system. It’s very much a last ditch resort. The craziest drug of all of them is called Melphalan, and it goes in your system for just an hour—just 60 minutes on the clock. It’s actually a cousin of mustard gas. You have to eat ice for an hour before, the hour during, and then the hour afterwards. Constantly. This drug is so fucking toxic that it will basically dissolve the inside of your mouth and digestive tract. If you don’t do this therapy by eating ice constantly, your mouth will just turn into a tube of sores.

That was when I went into a four-day extremely high fever. I don’t remember any of it. It was pretty dark. But for the other three weeks in the hospital, I was still able to work!

Kotaku: Goddamn. You decided to work in the hospital immediately after that crazy intense treatment?

Sam Coster: Yeah. I don’t really know how to put it into words, but having something that seems like it’s important—that you can always make progress on—I think was so key to me having a positive attitude the whole time. I always felt useful. I had something to do. I always had this big list of assets I needed to make. It was like, “Oh, we just got into the tundra biome, and we need six new creatures. So make your six creatures and fully animate them.”

That was also the first time in a year-and-a-half that I got to sit down and play through a whole game, so I played Dragon Age: Inquisition. That was super fun. Being in the hospital can be like a weird studio vacation if you can get your head out of, you know, being totally poisoned the whole time. I was very thankful that I had something to work on the whole time.

Kotaku: Despite all this real life darkness, Crashlands is a really funny, upbeat sort of game. Did the positive attitude that working on it inspired mould the tone of the game? Was cancer partially responsible for producing... happiness?

Sam Coster: Yeah, I mean I think it’s basically embedded in there. The whole project is supposed to deliver that sense of joy, awe, and a feeling of being lost in time that would allow someone in my position to literally not be there for a while. Just be in a really happy place. Granted, a lot of the games we’ve made are goofy. We like goofy things. We like making people happy. For us, that’s the point of making games. To be able to build a 60-hour experience where people are chuckle-snorting at themselves the whole time when they read the dialogue or even tool tips, it’s such a fun thing to deliver.

Kotaku: It’s such a different approach than other games developed with cancer looming over them or lurking in the background of developers’ lives. The most prominent example that comes to mind is That Dragon, Cancer. It’s more about conveying the experience of losing a loved one to cancer, of coping with a disease deserving of total obliteration by a hundred billion probing middle fingers. It’s about empathy. Your game, conversely, strikes me as escapism. Not in the dismissive way a lot of people use the term, but as a literal means to escape from a shitty situation. A respite.

Sam Coster: We talked to the That Dragon, Cancer guys at GDC last year. It’s another sort of damn cancer story. It was interesting chatting with [developer Ryan Green] because we all choose our own ways of dealing with it. His was this autobiographical experience of going through it, which is extremely powerful.

What I wanted to deliver was, if you didn’t know the game came out of a cancer diagnosis, then you wouldn’t know by playing it. Granted, there’s a boss in the bog called Toomah, who literally is cancer. You literally get to go kill cancer in this game. But very few people are gonna play through the game and go, “I bet this guy had cancer while he was making this.” The design of the game is all about making people have a really good time and lose themselves. That’s what I wanted and needed to have happen.

Kotaku: Right. And I feel like some people would look at the experience you created and claim it’s not as important as That Dragon, Cancer, or that it lacks artistic merit because it’s escapism. But that’s clearly not the case, nor is it a particularly useful line to draw.

Sam Coster: Yeah. And the craziest thing is, so we did a beta in November 2015. We started right before Thanksgiving, and we had about 150 people in it. We had three messages from people in that group, one of whom was going through a depressive, anxiety-ridden episode. He was a PHD student. Another had been dealing with PTSD from coming back from war. And then another guy was from the UK, and he was undergoing cancer treatment. Each one of those people separately—without us saying, “This is the point of the game”—sent us private messages saying, “Hey, I haven’t felt this way from playing a game in ten years.” Stuff like, “The amount I was able to lose myself in this game made me feel like a kid again.” That level of being carefree, running around harvesting stuff and punching Womp-Its in Crashlands.

We completed the beta, and some of our friends were like, “What are you guys’ criteria for success with this thing?” I think they were expecting us to give financial variables. And granted we had them. It cost money to make the thing. But at that moment, we just said, “It’s already successful. It’s good. We know it’s good because we gave it to people who we didn’t know needed it, and they responded literally in the exact way we’d designed the experience to have them respond.” It let them escape temporarily.

Kotaku: How did you keep above the, like, morass of bubbling shit that was rising all around you? I know you talked about feeling useful as a result of working on the game earlier, but even then, it sounds like things found ways to go from bad, to worse, to impossibly goddamn abysmal. I’ve had days where I felt like I couldn’t work because I just got sad for no apparent reason. Dumb little things like that. You were facing down something impossibly huge. How did you rewire your own brain to not fall into those traps?

Sam Coster: I did a lot of writing during the whole thing. Part of the thing I wanted to do was take the time after the new treatments to convert whatever the event was into a hilarious story. By which I mean one of those hilarious stories where you’re like, “Damn, I sure hope that never happens to me!” But it’s still funny at the end of the day.

One of them was when I was getting ready for that first stem cell treatment. They have to do radiation on you, and part of that is that you have to sit in the exact same spot when they shoot you every day. They don’t want to hit you in the lungs and stuff. So you come in, and they make this thing called an Alpha Cradle, which sounds so high-tech. So they told me about that, and I was like, “Oh sweet, this is gonna be some high-tech shit!” I went in, and it was literally a trash bag sitting on a board. You lay on that, and then they pore, like, insulation foam in the bag. The insulation foam rises up around your body, and that’s the mould they use. They sealed it up with scotch tape. I shit you not. I was like, “What is this nonsense?”

The best part is, then a female nurse shows up, and she’s like, “OK, I need you to take your goods...” And I was like, “My goods?” And she was like, “Yeah, I need you to put your goods into this cannon ball.” It’s called a clam shell, and it looks like a cannon ball. You have to put your junk in it so that it doesn’t get irradiated. I’m cracking up about this, and the nurse is like, “Do you need any help?” And I’m like, “Nah, I’ll take care of it. You can go.” So she leaves, and I struggle for two minutes because this thing is colder than hell. It felt like they put it in a freezer beforehand. On top of that, instead of having an intelligent closing mechanism, it’s literally just two halves, and they’re made of lead. Each one weighs around eight pounds, and you can pinch the shit out of yourself with this thing. I was like, “What is this? Who designed this process?” I’m a game developer, so I was thinking about how much better it could be.

Finally, I yelled over, “Hey, I think I got it!” She comes in, and she had to inspect it. I lifted up my gown, and she looked at me and went, “You don’t actually have to put your penis in it—just your testicles.” At that point we both lost it and just started cracking up. It was just such amazing nonsense.

So what really helped me was taking the time to share those stories with people. For whatever reason, it helps take the teeth out of it. Like, the first couple people I called and told that I had cancer, I was bawling the whole time. By the time I got to the 15th person on my list, I’d just call and be like, “Hey! I got cancer!” And they’re like, “Are you OK? You sound OK.” And I’m like, “I’m doing about as you’d expect, but I told a lot of people today, so I’m fine.” And they’re like, “Huh. OK then!”

But honestly, I think the telling of the stories helped me actively convert the experience from this terrible thing I spent time on to actually a source of entertainment and, weirdly enough, some joy for the people I was telling stories to.

The truth is, there were plenty of dark moments the whole time. You don’t know if you’re going to live. Fuck, I still don’t know. I finished my second stem cell transplant in September, and that was a donor one. My PET scan was clear in December, so I think I’m all good. But they don’t consider you cleared until five years pass. If you make it through one year, your potential rate of getting it again goes down a ton. But you know, I didn’t make it through a year last time. So every once in a while, I’m still like, “Oh fuck.” And then I need to go play some Diablo or something.

I think that escapism is super valuable for people. I know it gets knocked on a lot, but the reality is, most of us have stuff that sometimes we need more time to deal with than we’re given. More mental space. Games’ inherent quality of drawing people in and sticking them is the thing that helps you get out of your own head a little bit, get some distance. Enough to deal with it.

Kotaku: You mentioned that Crashlands does make one reference to your cancer, though, through the boss Toomah. Why you’d decide to make that part?

Sam Coster: So originally a few of the augments for your in-game weapons had a sort of cancer-killing connotation to them. For a while, instead of the antibodies one, there was, like, a Chestplate Of Destroy Lymphoma. It was so direct [laughs]. We replaced that. But I still wanted something where players could—maybe without even knowing it for 90 percent of them—go and kill cancer. The easiest way to do that was to turn him into a boss.

[Warning: Crashlands spoilers ahead.]

So through the storyline, you learn about how this thing is probably gonna fuck up the entire second biome in the game. This isn’t just a threat to a people; it’s a threat to an entire continent. You don’t even know if it’s gonna work when you go to destroy it. You have to prove it after you kill the damn thing. It’s meant to be goofy, but if you dwell on it for a moment, it’s a really terrifying and anxious thing. But at the end of the day, you get to kill it, which is great.

Toomah is a stationary boss. He’s a huge pile of mush with a face. The thing you learn about the bog itself—the entire second zone in the game—is that it’s a living entity. It spawns creatures, the race that lives there, and various mechanisms to keep itself alive and healthy. You learn about what appears to be a competing intelligence that has risen in the bog. It’s trying to slowly take over.

You end up finding out where the core of it is. You bring out Toomah, and he doesn’t directly attack you. He just won’t stop spawning minions, which of course is basically what cancer does. It just won’t quit growing. He has three different minion types, and no matter what you do, he just keeps on spawning. If you don’t hit him for a second or two, he starts regenerating his health. So it’s a fight where you have to put on a lot of pressure, and there’s this mounting infested growth situation. There’s tons of adds building up over time. You’ve got to take care of those too.

It was actually one of the hardest boss fights on accident during the beta, and we had to tone it down quite a bit.

Kotaku: Art imitates life.

Sam Coster: [laughs] Yeah, exactly.

Kotaku: How are you doing these days? Now that Crashlands is out, what’s next for you?

Sam Coster: The game launched a couple weeks ago. We made back the dev costs, so that’s good. We got to pay ourselves. Adam and Seth didn’t really take any paychecks until March of last year, and all of us were being paid I guess what you’d call “below the poverty line” for the last three years, so it’s good to finally be able to backpay ourselves at a reasonable rate.

It’s been weird. For a while, the course of the studio was, “Make games fast enough that the studio can survive.” Then the next two years was, “Make games fast enough that Sam’s not gonna be dead before they come out—and also he survives” [laughs]. My most recent PET scan came back clear, and that was as many months out from my last chemo as the time where it turned out I had cancer again. That one feels real to me. That feels good. I’ve had some complications from having somebody else’s blood system now, but they’re trivial things like being itchy and sometimes having my liver be attacked. It’s whatever.

We did not expect the response we’ve gotten with Crashlands. We’ve had so many people write in and be so happy about how the game makes them feel and how they’re able to spend so much time in it. The fact that we were able to successfully convert what was a very sort of doom-y situation into this 60-hour marathon of joy for thousands of people across the planet... it’s just very surreal. Being a game dev is odd in that you make a bunch of stuff, but the most exciting it gets is clicking a damn button to launch it. You just click. It’s not crossing the finish line with people cheering. It’s a pretty casual thing.

Even now, looking at the numbers of people playing and the revenue coming in—those are great, but it’s all numbers on a screen. So the only real connection we have is when people send us notes and say things like, “I haven’t connected with a game like this since the first time I played The Legend of Zelda.” Getting stuff like that is just wonderful. Absolutely wonderful. It shows us that we did it, and that we get to survive and keep on doing it. It wasn’t the case that we just survived as a studio or that I just survived the cancer treatment. We somehow managed to thrive in both of those dimensions at the same time. I’m incredibly proud.